11 Diabetes

Diabetes: meaning polydipsis/polyuria..

Diabetes Symptoms

Complications:

Diabetes Diagnosis

Diagnosis:..

Asymptomatic as in no polyuria/polydipsia..

Glucose Tolerance Test

Just measuring glucose level is not helpful because elevated in pregnancy
Measuring glucose load response more helpful..

Hemoglobin A1C

3 months because RBC lives for 3 months..

Type 1 Diabetes

aka insulitis

Islet cell antibodies are found in the vast majority of T1DM patients, as well as asymptomatic family members. Islet antigens that are the targets of autoimmune attack may include insulin and the β-cell enzyme glutamic acid decarboxylase (GAD).

Association with HLA-DR3 and DR4.

lifelong insulin

weight loss, low muscle mass, always wanting to eat

Diabetic Ketoacidosis

Type 2 still has insulin, thus less common

Trauma/infection increases epinephrine
Fruity breath from acetone
Dehydration -> hypotension
Ketones made from lipolysis
Oxaloacetate depletion from high NADH pushing towards malate
can get mild hyponatremia from loss of Na in urine

Patients with DKA and respiratory failure, always ckeck phosphate

Symptoms:

Hyperglycemia long term > brain makes taurine molecules to match osmolarity (doesn't happen in type 2)
Give fluid too fast > blood osmolarity drop
Water goes to brain, brain edema
Use IV mannitol to treat

Associated with mucormycosis:.

classic case: DKA patient in recovery with new onset fever/headache/eye pain

Treatment:

K lost in urine. Add K after a few hours of insulin

Type 2 Diabetes

more free FA bad because used for fuel instead of glucose
Left: apple shape. Right: pear shape..

Insulin Resistance

Type 2 associated with obesity
Adipocytes make TNF-a and FA
TNF-a and FA activates serine-threonine kinase
serine-threonine kinase phosphorylates beta chain, inhibits tyrosine phosphorylation
result is decreased number of available insulin receptors